Patient Portal Signup

The Patient Portal is a secure online website that gives our patients convenient 24-hour access to personal health information with an Internet connection. It is also an easy way to communicate with your Rural Health care team.  Please fill out the form below to request your patient portal account.  Note that this may take 24-48 hours to process your request.  Currently we are only enrolling individuals ages 0-13 and 18+

Patient Name (required)

Patient Date of Birth

Patient Phone Number

Patient Email Address (required)

Patient Primary Care Provider

Enter any comments here (re-registering, etc.)

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